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. 2025 Aug;15(4):e200434.
doi: 10.1212/CPJ.0000000000200434. Epub 2025 Jul 11.

Relationship Between Thrombolysis-to-Puncture Time and Outcomes of Endovascular Thrombectomy in Acute Ischemic Stroke

Xu Tong  1 , Baixue Jia  1 , Gaoting Ma  2 , Xuelei Zhang  3 , Jens Fiehler  4 , Fabian Flottmann  4 , Matthias Bechstein  4 , Gabriel Broocks  4 , Uta Hanning  4 , Helge C Kniep  4 , Götz Thomalla  5 , Milani Deb-Chatterji  5 , Gerhard Schön  6 , Yijun Zhang  7 , Feng Gao  1 , Ning Ma  1 , Dapeng Mo  1 , Zhongrong Miao  1 , Lukas Meyer  4 ; as the ANGEL-ACT & GSR-ET study group
Affiliations

Relationship Between Thrombolysis-to-Puncture Time and Outcomes of Endovascular Thrombectomy in Acute Ischemic Stroke

Xu Tong et al. Neurol Clin Pract. 2025 Aug.

Abstract

Background and objectives: Intravenous thrombolysis (IVT) followed by endovascular thrombectomy (EVT) improves functional outcomes in patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). There are limited data on the effect of thrombolysis-to-puncture time (TTP) on outcomes in patients with AIS undergoing IVT plus EVT.

Methods: We selected 1,104 patients receiving IVT + EVT for anterior circulation LVO stroke from 2 prospective nationwide registries (259 cases from ANGEL-ACT in China: November 2017 to March 2019, 845 cases from German Stroke Registry-Endovascular Treatment in Germany: June 2015 to December 2019). Based on the TTP, eligible patients were divided into 4 groups (≤30 min, 31-50 min, 51-70 min, and >70 min). The radiologic and clinical outcomes (e.g., successful recanalization [modified Thrombolysis in Cerebral Infarction score of 2b-3] at final angiogram, modified Rankin Scale [mRS] score of 0-2 at 90 days, any intracranial hemorrhage [ICH], and symptomatic ICH within 24 hours) among the 4 groups were compared by χ2 tests for trend and using multivariable logistic regression models.

Results: In the 4 groups from ≤30 min to >70 min, 226, 282, 230, and 366 patients were included, respectively. An increased TTP was associated with a lower chance of successful recanalization (p = 0.016) and mRS score 0-2 (p = 0.002). Compared with the group of ≤30 min, the group of >70 min was less likely to achieve successful recanalization (adjusted odds ratio [OR] = 0.47, 95% CI 0.25-0.89) and the groups of 50-70 min and >70 min had a reduced probability of mRS score 0-2 (adjusted OR = 0.50, 95% CI 0.33-0.78; adjusted OR = 0.56, 95% CI 0.37-0.85). No significant differences were found for any ICH or symptomatic ICH among the 4 groups after adjustment with potential confounders.

Discussion: Delay from thrombolysis to puncture should be minimized when considering bridging IVT before EVT for patients with AIS due to anterior circulation LVO. Further studies are warranted to verify and expand on these findings.

Trial registration information: ClinicalTrials.gov, NCT03370939 and NCT03356392.

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Conflict of interest statement

The authors report no relevant disclosures. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.TAKE-HOME POINTS→ In this pooled analysis of 2 nationwide registries, we found that shortening the time delay from IVT administration to groin puncture (start of EVT) was associated with a higher rate of successful recanalization and a better chance of 90-day functional independence.→ Our results, despite the stated limitations, support current guidelines to avoid EVT delay caused by observing for a clinical response after IVT if they are being planned for bridging therapy.→ Meanwhile, these results emphasize that within the time window of bridging therapy, time lapse equals brain damage.→ Therefore, our findings provide a basis for further trials to determine whether the functional outcome of patients with stroke can be significantly improved by optimizing the time from thrombolysis to thrombectomy.

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